What are migraine headaches?
More than just “a bad headache” — migraine is a debilitating and painful neurological disorder that seriously impacts the daily lives of millions of people. While migraine symptoms can be different for each person, the most common symptoms are usually severe throbbing or pulsating pain in only one side of the head. Unlike other types of headaches, a migraine attack can bring a heightened sensitivity to light, sound and smell, as well as nausea and vomiting.
At The Ohio State University Wexner Medical Center, our dedicated team of neurologists and headache specialists work with migraine sufferers every day. In fact, migraine is the most common headache condition we treat.
We understand that one migraine is never the same as the next. That’s why we’ll develop a customized treatment plan unique to you.
When should you see a neurologist or headache specialist?
If you routinely go to an urgent care or Emergency Department to manage your migraine attacks — or if you’ve tried multiple treatments or other remedies without success, you should see an Ohio State headache specialist. Call our office to get started.
What are ways to treat migraine attacks?
Our doctors can help you manage migraine symptoms by recommending over-the-counter or prescription medication, prescribing preventive medication, teaching you to avoid migraine triggers and giving you access to alternative treatment methods.
Pain-relieving medications
Over-the-counter medication such as triptans, nonsteroidal anti-inflammatory drugs, such as ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) can help relieve pain associated with migraine attacks.
How Botox can be a migraine treatment
Your doctor may prescribe Botox to help manage chronic migraine symptoms. If you have more than 15 migraine days per month, Botox injections in the face, neck and shoulders can help reduce your symptoms.
Preventive medications
Depending upon the frequency and severity of your migraine symptoms, your doctor can prescribe different medications to stop migraine attacks before they start. Preventive medications include beta-blockers, calcium channel blockers, tricyclic antidepressants and calcitonin gene-related peptide (CGRP) inhibitors. Preventive medications include:
Beta-blockers, including:
- Propranolol (Inderal)
- Metoprolol (Lopressor, Toprol-XL)
- Atenolol (Tenormin)
- Nadolol (Corgard)
Calcium channel blockers, including:
- Verapamil (Calan, Verelan)
ACE inhibitors and angiotensin II receptor blockers (ARBs):
- Lisinopril (Prinivil, Zestril)
- Candesartan (Atacand)
Tricyclic antidepressants
- Amitriptyline (Elavil)
- Nortriptyline (Pamelor)
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
- Venlafaxine (Effexor XR)
- Topiramate (Topamax, Trokendi XR)
- Valproate (Depakote)
- Atogepant (Qulipta)
- Erenumab (Aimovig)
- Fremanezumab (Ajovy)
- Galcanezumab (Emgality)
- Eptinezumab (Vyepti)
Abortive medications
Abortive (also called acute or rescue) medications are used to treat the pain caused by a migraine’s symptoms once it’s already begun. Abortive medications include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Ibuprofen (Advil, Motrin)
- Aspirin (Bayer)
- Naproxen (Aleve)
- Combination medications, including acetaminophen/aspirin/caffeine (Excedrin Migraine)
Triptans (selective serotonin receptor agonists, or SSRAs)
- Almotriptan (Axert)
- Eletriptan (Relpax)
- Frovatriptan (Frova)
- Naratriptan (Amerge)
- Rizatriptan (Maxalt)
- Sumatriptan (Imitrex)
- Zolmitriptan (Zomig)
Ergot alkaloids
- Dihydroergotamine (D.H.E. 45, Migranal)
- Ergotamine/caffeine (Cafergot, Migergot)
Ditans (selective serotonin 5-HT1F receptor agonists)
- Lasmiditan (Reyvow)
Calcitonin gene-related peptide (CGRP) receptor antagonists
- Ubrogepant (Ubrelvy)
- Rimegepant (Nurtec ODT)
- Zavegepant (Zavzpret)
Anti-nausea medications
- Metoclopramide (Reglan)
- Ondansetron (Zofran)
- Prochlorperazine (Compazine)
Additional medication options
Your doctor may prescribe corticosteroids, such as dexamethasone (Decadron) or prednisone, to shorten the length of a migraine. Muscle relaxants like cyclobenzaprine (Flexeril) and tizanidine (Zanaflex) are used to reduce tension. For some severe situations, opioids like butorphanol (Stadol NS) or oxycodone may help with higher-than-normal pain.
- Magnesium
- Riboflavin (vitamin B2)
- Coenzyme Q10
- Feverfew plant extract
- Butterbur plant extract
- Dietary changes, such as eliminating dairy products, sugar, alcohol or caffeine, can significantly reduce migraine symptoms.
- Sleep routines are a critical part of migraine treatment, in which patients follow a regular schedule to maintain good sleep hygiene.
- Hydrating throughout the day can prevent uncomfortable, dehydration-related headaches.
- Exercise helps to limit the severity and frequency of migraine symptoms.
Stress, anxiety or depression can lead to migraine attacks. Here are some ways you can address those underlying issues:
- Cognitive behavioral therapy (CBT)
- Mindfulness-based stress reduction (MBSR)
- Meditation
- Progressive muscle relaxation
- Deep breathing exercises
- Acupuncture – Pain relief can come from the insertion of thin needles into specific points on the body.
- Massage therapy – This can help reduce muscle tension and improve circulation and blood flow.
- Chiropractic care – Spinal manipulation and other chiropractic therapies can relieve migraine symptoms.
- Essential oils, like peppermint and lavender, can alleviate migraine symptoms for some.
- B12 and folate supplements – Some studies have suggested these supplements reduce migraine frequency for some sufferers.
- Capsaicin cream – When applied correctly, this cream (derived from pepper plants) can help reduce pain for some migraine sufferers.
Nerve decompression surgery for migraine
If other medications or treatments aren’t giving you any relief, as a last resort, surgery can be an option to address your migraine issues. Nerve decompression surgery removes muscle tissue, bone or blood vessels that constrict the nerves (which can cause migraine symptoms), giving more room and relieving your symptoms.
What causes migraine pain?
While the exact cause for migraine pain is unknown, researchers believe it’s how your brain and nervous system interact with each other. Increases or decreases in brain chemistry, such as serotonin levels, is one theory about how migraine pain starts. Genetics also seem to contribute to migraine development, as certain triggers are shared by parents and their children.
In general, the most common triggers or causes of migraine pain are:
- Stress
- Weather changes
- Second-hand cigarette smoke
- Dehydration
- Skipping meals
Certain foods are believed to be migraine triggers for some people, too, though there is no evidence to prove this.
How common is a migraine attack?
Migraine affects millions of people, regardless of their age, geographic location, fitness level or other factors. About one in seven adults worldwide experience migraine attacks, so you’re not alone. They are more commonly experienced by women than men (18% of women vs. 6% of men). While migraine symptoms can occur at any age, they impact people between the ages of 15 and 55 the most.
What are the stages and symptoms of a migraine attack?
Prodrome
The prodrome (initial) stage of a migraine attack is marked by subtle warning signs.
Prodrome symptoms include:
- Mood changes (e.g., irritability, depression)
- Food cravings
- Increased yawning
- Stiff neck
- Fatigue
- Increased thirst and urination
- Constipation or diarrhea
Aura
During the aura stage, you may experience temporary neurological symptoms like visual disturbances, sensory changes or some difficulty with speaking. These all typically precede the intense headache associated with your migraine.
Attack
The attack stage is characterized by a severe headache, often accompanied by nausea and sensitivity to light and sound. Lasting for a few hours to several days, this represents the peak intensity of your migraine episode.
Postdrome
Following the migraine attack, the postdrome phase involves a period of lingering symptoms like fatigue, difficulty concentrating and mild headache, as your body gradually recovers from the migraine episode.
What are the different types of migraine?
There are several different types of migraine, each with its own set of triggers and treatment strategies. At Ohio State, our team of headache experts is highly familiar with diagnosing and treating each migraine type.
The most common migraine types are:
- Migraine without aura – As the most common type of migraine, its symptoms can be severe, ranging from a throbbing headache in one side of the head, sensitivity to light and sound, nausea and vomiting. These can typically last up to 72 hours.
- Migraine with aura – This is preceded by visual or sensory disturbances before the headache arrives. Symptoms can include seeing flashes of light, blind spots, tingling in the hands or face, or speech difficulties. These last up to an hour before the migraine itself.
- Chronic migraine – This is defined as having 15 or more migraine days per month, for multiple months.
- Migraine with brainstem aura (formerly known as “basilar-type migraine”) – This type affects the brainstem, which causes severe, disorienting neurological symptoms. Among the symptoms are vertigo, speech difficulties, loss of balance and ringing in the ears.
- Hemiplegic migraine – This migraine can cause temporary paralysis or sensory changes on one side of the body, such as weakness, numbness or tingling. Vision changes and difficulty with speaking are also common.
- Retinal migraine – This migraine affects vision in only one eye, with symptoms including temporary blindness, followed by a headache.
- Abdominal migraine – This migraine has symptoms that include abdominal pain, nausea and vomiting. It’s unique because it does not present itself as a headache.
- Vestibular migraine – Disorientation and vertigo are the hallmarks of this migraine, which has symptoms like dizziness, balance problems and sensitivity to motion. It can last for minutes or hours.
Are migraine related to concussions?
Both migraine and concussions cause similar symptoms. These can include headaches, dizziness, nausea, sensitivity to light and sound, and cognitive difficulties like trouble concentrating or memory problems.
Both conditions involve disruptions in brain function. Migraine are thought to involve abnormal brain activity affecting nerve pathways and brain chemicals, while concussions cause direct physical disruption to brain cells and structures from trauma.
In migraine, changes in brain blood flow and inflammation are part of the headache process. Following a concussion, inflammation and altered blood flow can also contribute to ongoing symptoms, including migraine symptoms.
A concussion can lead to the following conditions:
- Post-traumatic headache – Following a concussion, post-traumatic headaches are common. These headaches often have migraine-like features such as throbbing pain, sensitivity to light and sound, and nausea.
- Triggering migraine – A concussion can trigger the onset of migraine in individuals who have never had them. They can also make the severity and frequency of migraine much worse in those who’ve had them before.
- Chronic post-concussion syndrome: Some people can develop chronic post-concussion syndrome (PCS) after head injuries. These symptoms can persist for weeks or months at a time. Chronic headaches may resemble migraine symptoms and are a common part of PCS.
